Dataset Information

H₂ FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

ABSTRACT:

Aims

The prediction of future heart failure (HF) in stable outpatients is often difficult for general practitioners and cardiologists. Recently, the H₂ FPEF score (0-9 points) has been proposed for the discrimination of HF with preserved ejection fraction from non-cardiac causes of dyspnoea. The six clinical and echocardiographic variables that constitute the H₂ FPEF score include the following: (i) obesity (H); (ii) the use of ?2 antihypertensive drugs (H); (iii) atrial fibrillation (F); (iv) pulmonary hypertension (P); (v) an age > 60 years (E); and (vi) E/e' > 9 (F). We performed an external validation study that investigated whether the H₂ FPEF score could predict future HF-related events in stable outpatients with cardiovascular risk factor(s) in Japan.

Methods and results

In this prospective cohort study, after exclusion of 195 from 551 consecutive, stable Japanese outpatients with at least one cardiovascular risk factor who were enrolled between September 2010 and July 2013, the remaining 356 outpatients (171 men, 185 women, mean age 73.2 years) were eligible for the analysis. We calculated the H₂ FPEF score (0-9 points), and followed up the patients for an average of 517 days. In all of the 356 patients, the mean H₂ FPEF score was 3.1 ± 1.8, and 15 developed HF-related events during the follow-up period, including cardiovascular death (n = 2) and hospitalization for HF decompensation (n = 13). Multivariate Cox proportional hazards analysis showed that the H₂ FPEF score was an independent predictor of future HF-related events (P < 0.001 for all three models). Kaplan-Meier survival curves showed a significantly higher probability of HF-related events in the outpatients with a high H₂ FPEF score (P < 0.001). In receiver operating characteristic (ROC) curve analysis, the H₂ FPEF score was significantly associated with the occurrence of future HF-related events (P < 0.001). In ROC curve analysis, the sensitivity, specificity, and positive likelihood ratio of a H₂ FPEF score of 7 points to predict HF-related events were 47%, 96%, and 11.4%, respectively.

Conclusions

The H₂ FPEF score could provide useful information for future HF-related events in stable outpatients with cardiovascular risk factor(s) in Japan.

SUBMITTER: Suzuki S

PROVIDER: S-EPMC7083475 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

H<sub>2</sub> FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

Suzuki Satoru S Kaikita Koichi K Yamamoto Eiichiro E Sueta Daisuke D Yamamoto Masahiro M Ishii Masanobu M Ito Miwa M Fujisue Koichiro K Kanazawa Hisanori H Araki Satoshi S Arima Yuichiro Y Takashio Seiji S Usuku Hiroki H Nakamura Taishi T Sakamoto Kenji K Izumiya Yasuhiro Y Soejima Hirofumi H Kawano Hiroaki H Jinnouchi Hideaki H Matsui Kunihiko K Tsujita Kenichi K

ESC heart failure 20200122 1

<h4>Aims</h4>The prediction of future heart failure (HF) in stable outpatients is often difficult for general practitioners and cardiologists. Recently, the H<sub>2</sub> FPEF score (0-9 points) has been proposed for the discrimination of HF with preserved ejection fraction from non-cardiac causes of dyspnoea. The six clinical and echocardiographic variables that constitute the H<sub>2</sub> FPEF score include the following: (i) obesity (H); (ii) the use of ≥2 antihypertensive drugs (H); (iii) a ...[more]

PMID: 31967406

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Project description:AimsThe aim of this study was to assess the prognostic value of the H2 FPEF score in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF).Methods and resultsIn this multicentre study, a total of 832 patients from two German high-volume centres, who received TAVI for severe AS and preserved EF (?50%), were identified for calculation of the H2 FPEF score. Patients were dichotomized according to low (0-5 points; n = 570) and high (6-9 points; n = 262) H2 FPEF scores. Kaplan-Meier and Cox regression analyses were applied to assess the prognostic impact of the H2 FPEF score. We observed a decrease in stroke volume index (-2.04 mL/m2 /point) and mean transvalvular gradients (-1.14 mmHg/point) with increasing H2 FPEF score translating into a higher prevalence of paradoxical low-flow, low-gradient AS among patients with high H2 FPEF score. One year after TAVI, the rates of all-cause (low vs. high H2 FPEF score: 8.0% vs. 19.4%, P < 0.0001) and cardiovascular (CV) mortality (1.9% vs. 9.0%, P < 0.0001) as well as the rate of CV mortality or rehospitalization for congestive heart failure (6.4% vs. 23.2%, P < 0.0001) were higher in patients with high H2 FPEF score compared with those with low H2 FPEF score. After multivariable analysis, a high H2 FPEF score remained independently predictive of all-cause mortality [hazard ratio 1.59 (1.28-2.35), P = 0.018] and CV mortality or rehospitalization for congestive heart failure [hazard ratio 2.92 (1.65-5.15), P < 0.001]. Among the H2 FPEF score variables, atrial fibrillation, pulmonary hypertension, and elevated left ventricular filling pressure were the strongest outcome predictors.ConclusionsThe H2 FPEF score serves as an independent predictor of adverse CV and heart failure outcome among TAVI patients with preserved EF. A high H2 FPEF score is associated with the presence of paradoxical low-flow, low-gradient AS, the HFpEF in patients with AS. By identifying patients in advanced stages of HFpEF, the H2 FPEF score might be useful as a risk prediction tool in patients with preserved EF scheduled for TAVI.

Project description:BackgroundDespite advancements in pharmacological and device-based treatment, heart failure (HF) continues to impose an enormous burden for health care system worldwide. Decompensation of HF is one of the main causes of hospitalization, therefore the identification of patients with the highest risk of such complication is still of great clinical importance. The prognostic significance and utility of global longitudinal strain (GLS) has been previously studied in patients with the broad spectrum of cardiovascular diseases in various endpoints, however its role in assessing the risk of hospitalization due to HF exacerbation of optimally treated outpatients has not been fully explored. Therefore, the aim of the study was to verify whether the GLS of the left ventricle (LV) derived by 2D speckle tracking echocardiography has, independently of other well-known clinical parameters, an additional impact on the risk of HF decompensation in stable patients with LV systolic dysfunction of ischemic origin.MethodsIn 193 clinically stable HF outpatients with LV ejection fraction (LVEF) ≤ 50%, GLS, additionally to other clinical parameters, was analyzed. During 34 (14-71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT).ResultsEVENT was significantly associated with age, QRS width, NYHA functional class, left atrium diameter, LV systolic and diastolic volume, LVEF, hemoglobin, brain natriuretic peptide, diuretic treatment, absence of beta-blockers, impaired renal function and history of diabetes in univariate Cox analyzes. GLS with pre-specified cut-off value of -9.4% was also significantly associated with the EVENT (HR 15.16; 95% CI 1.81-126.91). After adjusting for above-mentioned parameters GLS was still a significant predictor of hospitalization due to HF decompensation.ConclusionsGLS measurement can provide incremental information on the risk of HF decompensation in stable outpatients with LV systolic dysfunction of ischemic origin.

Dataset Information

H₂ FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

Aims

Methods and results

Conclusions

Publications

H<sub>2</sub> FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

H2 FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

Aims

Methods and results

Conclusions

Publications

H<sub>2</sub> FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

H₂ FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors.